Provider Demographics
NPI:1558382333
Name:FIELDS, RICHARD L (FNP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:FIELDS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1459
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912
Mailing Address - Country:US
Mailing Address - Phone:406-892-3208
Mailing Address - Fax:406-892-4535
Practice Address - Street 1:2165 9TH ST WEST
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912
Practice Address - Country:US
Practice Address - Phone:406-892-3208
Practice Address - Fax:406-892-4535
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTR11441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT437489Medicaid
MT437489Medicaid
82037Medicare ID - Type Unspecified